The latest list of top CEOs in the United States includes nearly a dozen health care executives, but hardly any from companies that specialize in home health services.

The sole home health exec that did make the cut: Great Lakes Caring Home Health and Hospice CEO Adam Nielsen.

Glassdoor, one of the world’s largest job and recruiting platforms, recently released its top CEOs of 2018 list, an annual ranking of the 100 most successful execs based on anonymous employee feedback and corresponding approval ratings.  Among the more than 770,000 employers reviewed on Glassdoor, the average CEO approval rating is 69%. Nielsen’s approval rating, in comparison, checked in at 93% during the past year. It has gone up even further lately, too, currently sitting at 97%, according to Glassdoor.

That upward trend is especially noteworthy due to the fact Great Lakes Caring was involved in a three-way merger about two months ago.

Michigan-based Great Lakes Caring, Connecticut-based National Home Health Care and Texas-based Jordan Health Services finalized a combination deal in May, creating one of the largest home-based care providers in the country in the process. As a merged enterprise operating throughout the personal care, skilled home health and hospice spaces, the companies will together serve more than 63,000 patients and employ more than 31,000 caregivers across more than a dozen states.

“Nobody is worried about our care changing at all,” Rebecca Schnipkey, a hospice licensed practical nurse for Great Lakes Caring, told Home Health Care News. “We all know how important that is to [Nielsen] and the company, so I don’t think the merger has been a concern to anyone.”

Nielsen checked in at No. 61 on Glassdoor’s top CEO list for large companies.

Randy Bufford from Trilogy Health Services also represented the aging services field on the list, along with CEOs from several hospital and health systems, including St. Jude Children’s Research Hospital,  NewYork Presbyterian Hospital, MD Anderson Cancer Center and others.

Eric Yuan, CEO of Zoom Video Communications, came in at No. 1 overall.

Employees have filed more than 40 million reviews and insights on Glassdoor, according to the company. To qualify for a top CEO spot for large companies, CEOs must have received at least 100 approval ratings and 100 senior management ratings between May 2, 2017 and May 1, 2018. They also needed to have overseen businesses with at least 1,000 total employees.

Secrets to success for home health CEOs

Nielsen may have gone into Glassdoor’s ranking as CEO for Great Lakes Caring, but he now holds an even broader title as well.

Under the leadership structure of the Great Lakes-National-Jordan merger, Nielsen officially serves as CEO of the enterprise’s home health and hospice branch. Scott Herman, meanwhile, serves as enterprise-wide CEO.

Earning a spot on Glassdoor’s top CEO list for 2018 is a personal accomplishment, but it also is reflective of Great Lakes Caring’s entire team and its ability to maintain stability in an unpredictable regulatory climate and a bustling M&A landscape, Nielsen told HHCN.

Ultimately, receiving such high approval ratings means that Nielsen, management, office staff and clinicians are, for the most part, all on the same page, he said.

“I view it not as a report card on just me, but as a report card on our management team and how we are addressing the changing environment,” Nielsen said. “If we’re having higher marks, that means our employees are believing in their management, and that management is working together.”

By nature, being a CEO can be a stressful, difficult job. Being a home health CEO—somebody who has to lead a largely remote workforce and balance profits with high-quality care—can be even tougher.

At Great Lakes Caring, Nielsen has succeeded in his role, which he has held for a little more than a year, by encouraging communication and acting on feedback, he said. A big part of his leadership strategy has also focused on going out to all the provider’s branches and trying to forge personal connections with the workforce, and making sure everyone is working toward the same goal of providing high-quality care for patients.

“We survey our employees frequently, asking them what they want, what can make their lives better,” he said. “We want to know what they think, and whenever we receive surveys back, we act on that.”

Prior to becoming CEO in 2017, Nielsen served as president. Before that, he was vice president of corporate strategy and business development.

Nielsen’s communication-first approach has undoubtedly boosted business.

Since he became CEO, Great Lakes Caring has seen a 14% growth in revenue and a 14% growth in employee base, according to the company. It has also expanded several of its current service areas, while opening a new branch in Kittery, Maine.

“Things are very good for us,” Nielsen said. “We continue to see growth, we continue to see an importance placed on the continuum of care.”

Employee perceptions  

Research conducted by Glassdoor economists Andrew Chamberlain and Ruoyan Huang suggests that CEO approval is strongly linked to CEO pay, company culture, work-life balance and company performance.

On average, higher CEO compensation is statistically linked to lower CEO approval ratings, though that can be somewhat lessened when employees are satisfied with company culture, according to the researchers. CEOs of more profitable companies typically receive higher approval ratings on Glassdoor, even after statistically controlling for the impact of extraneous factors such as industry and company size.

Still, robust financial results don’t always lead to strong CEO approval ratings, Walt Rakowich, a leadership speaker, former CEO and widely cited expert on company culture, told HHCN via email.

“… CEOs experience pressure to produce strong financial returns,” Rakowich, who currently serves on the board of directors for real estate investment trust (REIT) Ventas, Inc. (NYSE: VTR), said. “But [they can’t] let bottom line concerns override the importance of building a great workplace culture—they’re not mutually exclusive.”

Looking ahead

Before becoming a nurse earlier this year, Schnipkey worked in the sales and marketing division for Great Lakes Lakes Caring for more than five years, giving her a unique perspective on Nielsen’s strengths as a home health CEO, she said.

“While working in sales and marketing, we worked hand-in-hand with [Nielsen] on what our mission was, what we wanted to see in terms of outcomes with patients, what our goals needed to be,” Schnipkey said. “He preached what we needed to do every day, and his goal was to provide the best patient care around.”

Schnipkey expects that commitment to high-quality care to continue as Great Lakes Caring begins to figure out its place in the combined enterprise with National Home Health Care and Jordan Health Services, she said.

One of the biggest challenges of that merger, according to Nielsen, will be making sure the cultures of all three companies can seamlessly work together in a larger enterprise.

“We’re on track for doing what we’ve set out to do,” Nielsen said. “We continue to bring together the organizations and continue to bring together a common culture. … Any time you do an acquisition, in general, it’s a challenge to bring that together.”

Written by Robert Holly